Unique Plan Description: Insulin Drip Protocol Adult (FH)
Plan Selection Display: Insulin Drip Protocol Adult (FH)
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2020-04-21 15:52:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-04-18 13:10:14
Available at all facilities: No

Insulin Drip Protocol Adult (FH)
Laboratory
	Glucose POC - RN
		T;N, Q1H
		T;N, As needed for signs and symptoms of hypoglycemia
IV Solutions
		Discontinue any previous insulin and/or oral diabetic medication orders when starting insulin drip.(NOTE)*
	insulin regular 100 units/NS 100 mL Premix
		100 mL, IV, Routine, T;N, T;N, Titrate, Total Volume = 100
			Comment: concentration: 1 unit/mL, Initial rate based on initial glucose:  181-300: 2 units/hr;  301-400:  3 units/hr; 401 or greater: 4 units/hr;   Titrate infusion to target glucose of 120-180:  If glucose is:1) Less than 100 discontinue infusion,continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >120.2) 100-120, decrease infusion by 1 unit/hr.3) 121-180, no change.4) 181-249, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr.5) 181-249, and is less than the previous glucose, maintain same rate.6) 250-350, increase infusion by 1 unit/hr.7) > 351, increase infusion by 2 unit/hr.  Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician
		100 units, EVERY BAG
			Comment: INITIAL Infusion Rate: glucose 200-249mg/dl: 4 units/hr; 250-299mg/dl: 6 units/hr; 300-399md/dl: 8 units/hr; > 400mg/dl: 10 units/hr.  Titrate to a target glucose of 140-200.  MAXIMUM rate of 40 units/hr.  Call physician for direction if unable to reach goal range.  DO NOT enter as a basic infusion in pump1. If glucose is < 60, HOLD DRIP and give 1 amp 50% glucose and check POC glucose every 30 minutes until >   100mg/dl and then re-initiate drip at 50% previous rate2. If glucose is 60-80, HOLD DRIP and check POC glucose every 30 minutes until > 100mg/dl and then re-initiate   drip at 50% previous rate3. If glucose is 81-100 mg/dl    a. Previous glucose 60-80, decrease rate by 1 unit/hr    b. Previous glucose 81-139, decrease rate by 0.5units/hr    c. Previous glucose 140-250, decrease rate by 1 unit/hr    d. Previous glucose 251-300, decrease rate by 1.5units/hr    e. Previous glucose >300, decrease rate by 2 units/hr4. If glucose is 101-139 mg/dl    a. Previous glucose <101, NO CHANGE    b. Previous glucose 101-200, decrease rate by 0.5units/hr    c. Previous glucose > 200, decrease rate by 1unit/hr5. If glucose is 140-200 mg/dl    a. Previous glucose < 101, increase rate by 1 unit/hr    b. Previous glucose 101-250, NO CHANGE    c. Previous glucose > 250, decrease rate by 2 units/hr6. If glucose 201-250 mg/dl    a. When Blood Glucose is < 250 mg/dl, update IV fluid to dextrose containing fluid.  If no fluids on patient       profile,     start D5%-Normal Saline 0.9% at 50mL/hr.    b. Previous glucose < 139, increase rate by 2 units/hr    c. Previous glucose 140-300, increase rate by 1 unit/hr    d. Previous glucose >300, NO CHANGE7. If glucose 251-300 mg/dl    a. Previous glucose < 101, increase rate by 2.5 units/hr    b. Previous glucose 101-139, increase rate by 1.5 units/hr    c. Previous glucose 140-250, increase rate by 1 unit/hr    d. Previous glucose 251-300, increase rate by 1.5units/hr    e. Previous glucose 301-400, increase rate by 2 units/hr    f. Previous glucose > 400, NO CHANGE8. If glucose 301-400 mg/dl    a. Increase rate by 3 units/hr9. If glucose > 400 mg/dl    a. Increase rate by 4 units/hr
	insulin regular 100 units/NS 100 mL IV
		100 mL, IV, Routine, T;N+960, Titrate, Total Volume = 100
			Comment: concentration: 1 unit/mL, Initial rate based on initial glucose:  181-300: 2 units/hr;  301-400:  3 units/hr; 401 or greater: 4 units/hr;   Titrate infusion to target glucose of 120-180:  If glucose is:1) Less than 100 discontinue infusion,continue blood glucose monitoring and follow Insulin IV infusion hypoglycemia treatment parameters if necessary; restart drip at 1/2 previous rate when glucose >120.2) 100-120, decrease infusion by 1 unit/hr.3) 121-180, no change.4) 181-249, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr.5) 181-249, and is less than the previous glucose, maintain same rate.6) 250-350, increase infusion by 1 unit/hr.7) > 351, increase infusion by 2 unit/hr.  Contact MD if rate >10 unit/hr.  If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physician
		100 units, EVERY BAG
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, Routine, 50 ml/hr, Total Volume = 1,000
			Comment: Begin if patient not currently on dextrose containing IV or TPN when glucose is 200 or less.  If patient has a current IV order that doesn't contain dextrose, add dextrose to that IV and do not start this D5/45 Order.
Medications
	insulin regular
		5 units, Solution-Injection, IV Push, Once, PRN, see comment
			Comment: Prior to starting insulin drip if initial blood glucose 301 or greater
	Dextrose 50% injection
		25 mL, Injection, IV Push, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	Dextrose 10% in Water (FH)
		250 mL, Injection, IVPB, Q30MIN, PRN for low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 60mg/dL or 60-70 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	glucagon
		1 mg, Injection, IM-Intramuscular, Q15MIN, PRN for low blood sugar, Routine, T;N
			Comment: Give if blood glucose < 70mg/dL AND if dextrose 50% injectable unavailable OR inadequate response to IV dextrose 50%. May give SubQ or IM if patient does not have IV access. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	Notify MD
		T;N, for instructions if dietary change: abrupt change in oral intake, change to NPO status, tube feedings are held or discontinued, TPN held or discontinued.  (caloric intake necessary to prevent hypoglycemia)
		T;N, If insulin requirements > 10units/hr for further instruction
	Notify MD of Lab results
		T;N, if blood glucose is not less than 180 after 6 hours on the Insulin IV Infusion protocol.
	IV Insulin Parameters
		T;N, Decrease infusion to 0.5 units/hour if enteral and/or parenteral nutrition support is stopped or held and notify physician.
		T;N, If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes.
		T;N, If initial glucose < 180, do not start infusion.  Enter order for blood glucose Q4H and start infusion if necessary based on parameters.
		T;N, When glucose </= 200, and patient not on a dextrose containing IV/TPN: add D5W to current IV.  Continue same IV base, electrolytes and rate.  If patient not currently on IV or TPN, initiate D5W/0.45% sodium chloride.
	Order Lab
		When glucose is in target range (121-180) for 6 hours, cancel glucose Q1H order and enter new glucose order Q2H.  If glucose falls out of target range, change glucose checks back to Q1H until in range again for 6 hours.
	Hypoglycemia Treatment Parameters
		T;N, If glucose </=60 mg/dL, discontinue infusion and give 25 mL of Dextrose 50%, and call MD.  Repeat glucose 15 min after treatment. May repeat dextrose if blood glucose still < 60 or give juice as per protocol.
		T;N, If glucose 60- 70 mg/dL, discontinue infusion and administer 120mL apple juice.  If patient NPO or unable to tolerate oral intake, may give Dextrose 50%, 25mL.  Repeat glucose in 15 minutes after treatment.    If repeat glucose is 60-70, give another
			Comment: 120mL apple juice or 25mL Dextrose 50% if NPO and call MD, repeat glucose in 15 minutes.  If repeat glucose is 71-120, do not restart infusion, continue to check blood glucose and monitor for hypoglycemia symptoms Q1H.
		T;N, When blood glucose is greater than 120 mg/dL, restart infusion at 1/2 previous rate and change glucose checks to every hour until glucose is in the target range (121-180) for 6 hours, then may change to Q2H glucose checks.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase